Saturday, July 13, 2024

Expert endorses HCQ as a safe drug for rheumatic diseases

: Hydroxychloroquine, or HCQ as it is commonly known, belongs to the family of medicines called “antimalarials” and is also classified as a disease-modifying anti-rheumatic drug (DMARD).HCQ was chemically synthesized in 1944 and was found effective for rheumatoid arthritis (RA)and lupus, which led to its approval in 1956 by the U.S. Food and Drug Administration for the treatment of these two conditions.

HCQ is safe, effective and one of the most frequently used drugs for the treatment of autoimmune rheumatic diseases. In these autoimmune diseases, the immune system mistakenly attacks the cells of the body and causes different symptoms. HCQ is prescribed for these conditions because it is an “immunomodulatory” drug that affects different functions of the cell and immune system but does not suppress the immune system.

Commenting about the drug and its efficacy, Dr. Banwari Sharma, Clinical Immunologist & Rheumatologist, said, “The drug has been used around the world for almost 6 decades and has an excellent safety profile. It is the only anti-rheumatic drug that does not require routine blood monitoring, even when it is used for a long time. HCQ is safe for patients with rheumatic disease during pregnancy and while breast feeding. Moreover, autoimmune rheumatic diseases lead to chronic inflammation that significantly increases the risk of cardiovascular morbidity and mortality. Fortunately, HCQ inhibits atherosclerosis by reducing bad cholesterol (LDL), increasing good cholesterol (HDL) and it also reduces clot formation. Many rheumatologists called HCQ a “wonder drug” for rheumatic diseases.”

Some common adverse reactions with HCQ are skin hyperpigmentation, gastritis and retinal side effects that may occur after using the drug for 5 to 10 years. These reversible side effects can be detected at yearly eye examination by an eye specialist.

Speaking about recent reports on the drug, Dr. Banwari Sharma, said, “In my experience of 20 years, I have not seen any cases of significant cardiotoxicity with HCQ in my rheumatic disease patients. HCQ has recently been used for COVID-19 prophylaxis and treatment. The data so far are conflicting. A few studies have shown increased cardiotoxicity with HCQ use in these patients. However, since myocarditis and cardiac arrhythmias are commonly seen in COVID-19, it is difficult to confirm the exact reason for cardiotoxicity. Moreover, the drug dosage used was three times higher than what we prescribe for those with rheumatic diseases, and it was used in combination with another drug.  Studies published in prestigious medical journals NEJM and The Lancet that showed that HCQ has no  benefit in COVID-19 and caused increased cardiotoxicity were subsequently questioned by the medical fraternity and their authors could not provide the source of data, which led to both journals retracting the papers1-2.”

“As a rheumatologist, I can say this is one of the cheapest, safest, and most trustworthy drugs for autoimmune disease.  Those who have been prescribed HCQ should take it exactly as prescribed. However, while this drug is safe and effective, it should only be taken if and when prescribed by a rheumatologist,” Dr. Banwari Sharma emphasized.

  1. RETRACTED: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis Prof Mandeep R Mehra, MD  Sapan S Desai, MD Prof Frank Ruschitzka, MD Amit N Patel, MD Published: May 22, 2020DOI:https://doi.org/10.1016/S0140-6736(20)31180-6
  2.  Retraction: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med. DOI: 10.1056/NEJMoa2007621.

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